Emergency Medicine Journal最新文献

{"title":"Caring for carers.","authors":"Mary Dawood","doi":"10.1136/emermed-2024-214838","DOIUrl":"10.1136/emermed-2024-214838","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"164"},"PeriodicalIF":2.7,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142964186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency medicine advanced clinical practitioners: an English workforce census.","authors":"Jamie Squire, Jonathon Thompson, Christopher Boyes","doi":"10.1136/emermed-2024-214483","DOIUrl":"10.1136/emermed-2024-214483","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"200-201"},"PeriodicalIF":2.7,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What should be documented for an anterior shoulder dislocation? A Delphi study.","authors":"Niels van der Naald, Lukas P E Verweij, Michel P J Van Den Bekerom, Lucia F J Walraven, David Nico Baden","doi":"10.1136/emermed-2024-214347","DOIUrl":"https://doi.org/10.1136/emermed-2024-214347","url":null,"abstract":"<p><strong>Background: </strong>Standardised consensus-based documentation following anterior shoulder dislocation in the ED might improve clinical quality, reduce heterogeneity in research and reduce workload. The aim of this study was to determine important elements and the extent of variability for the ED documentation following anterior shoulder dislocation.</p><p><strong>Methods: </strong>An expert panel of physicians who perform the documentation (emergency physicians) of diagnosis and management of anterior shoulder dislocation and those who may read it (orthopaedic surgeons and general practitioners) was recruited in a three-round Delphi design between May and November 2022. Important elements were identified for history, physical examination, additional examinations, reduction technique and miscellaneous. These were rated on a 0-9 Likert scale. Consensus was reached when ≥80% scored 7-9. Another, independent, outcome was high variability in opinion, defined as at least one score between 1 and 3 and one score between 7 and 9 on an item after the third round.</p><p><strong>Results: </strong>The expert panel consisted of 22 emergency physicians, 5 general practitioners and 3 orthopaedic surgeons. In the first round, 85 elements were identified, and consensus on importance was reached in 22 out of the 85 elements: <i>medical history</i> (5 out of 30), <i>physical examination</i> (5 out of 18), <i>additional examinations</i> (5 out of 9), <i>reduction</i> (5 out of 17) and <i>miscellaneous</i> (2 out of 11). High variability in importance was seen in 79 (93%) out of the 85 elements after the third round.</p><p><strong>Conclusion: </strong>A consensus on 22 out of the 85 elements was reached and could be included in the ED documentation on anterior shoulder dislocation. Regardless of this consensus, high variability was observed in almost all the elements, highlighting the difference in opinions. Nevertheless, these elements could facilitate more concise communication among healthcare professionals and could facilitate homogenous datasets.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practitioner experiences of developing and implementing two UK ED-based hospital violence intervention programmes: a process evaluation.","authors":"Simon Moore, Jordan Van Godwin, Graham Moore, Megan Hamilton, David O'Reilly","doi":"10.1136/emermed-2024-214333","DOIUrl":"https://doi.org/10.1136/emermed-2024-214333","url":null,"abstract":"<p><strong>Background: </strong>EDs can address modifiable risks of patients attending due to violence. Hospital-based violence intervention programmes (HVIPs) can reduce patients' exposure to violence but can place additional burdens on staff. We explored practitioners' views on two nurse-led HVIPs' design and delivery, response to patient need, engagement with ED health professionals, adaptation to local context and analysed documents relevant to these objectives.</p><p><strong>Methods: </strong>This was a qualitative process evaluation, from January to September 2023, of two nurse-led HVIPs implemented in a major trauma centre and a large urban hospital in the UK. Interview participants (N=49) were involved with the commission and implementation of the HVIPs, or worked within the broader violence-prevention ecology. We gathered perspectives on intervention implementation and undertook documentary analysis on local and national policies, and guidance relating to HVIPs development, implementation and delivery (N=46). Documentary data were subject to thematic and content analyses, interview data to thematic analysis.</p><p><strong>Results: </strong>HVIPs were developed in response to a perceived under-provision of services for patients attending EDs due to violence. The HVIP nurses had access to clinical records facilitating the identification of eligible patients. They provided patient-centred care, addressing needs through referrals into health and community-based services. Over 60% of eligible patients engaged. The nurses were seen as credible champions working towards a minimally burdensome service that supported and trained ED staff. Embedding HVIPs into usual care took time and was limited by the perceived short-term nature of the intervention.</p><p><strong>Conclusion: </strong>The implementation of nurse-led HVIPs enables access to clinical records, facilitating patient engagement, and can provide an additional service aligned to usual emergency care, supporting both patients and ED staff.</p><p><strong>Pre-registration: </strong>The protocol was pre-registered (ISRCTN 15286575; March 13, 2023) and published before data collection was complete.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143413638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multicentre cross-sectional study to assess nursing workload in Belgian emergency departments.","authors":"Thomas Ganty, Julien Szecel, Anh Diep, Alexandre Ghuysen, Méryl Paquay","doi":"10.1136/emermed-2024-214334","DOIUrl":"https://doi.org/10.1136/emermed-2024-214334","url":null,"abstract":"<p><strong>Background: </strong>Excessive workload in emergency departments (ED) negatively affects patient safety, often leading to missed critical tasks due to time constraints. The Workload Assessment of Nurses on Emergency (WANE) scale developed in Belgium offers a detailed measurement of nursing workload, but its complexity makes it hard to use in practice. Our study aims to find a simpler method for assessing nursing workload in EDs.</p><p><strong>Methods: </strong>A multicentre cross-sectional study was performed in four Belgian EDs between September 2022 and March 2023. Nursing workload was assessed using the WANE scale in each hospital, during 4-hour time periods. The associations between WANE scores, and nurses' subjective workload assessment, number of patients, patient triage levels, post-triage destination area and the Jones Dependency Tool Score were examined employing multiple linear regression models.</p><p><strong>Results: </strong>161 nurses, caring for 591 patients, were included. 67% of the variation in 'direct' care time could be explained with a model based on triage level and two items of the Jones Dependency Tool (ABC perturbation and mobility). The number of new patients admitted and nurses' perceived workload were also highly associated with the total nursing care time TNCT. The actual number of patients in the ED at any time explained 78% of the variation in TNCT. Each additional patient increases the TNTC by 45.22 min.</p><p><strong>Conclusions: </strong>Simple indicators might be used to evaluate the nursing care time in Belgian EDs. A retrospective method is suggested, using the total number of patients over a defined period of time. This study reveals a path to a predictive method to calculate the direct care time for each patient with three simple indicators, available from nursing triage stage.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143413637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors influencing paramedic conveyance decisions when attending children with minor head injury: a qualitative study.","authors":"Alyesha Proctor, Jedd Billing, Mark Lyttle, Sarah Voss, Jonathan Benger","doi":"10.1136/emermed-2024-214467","DOIUrl":"https://doi.org/10.1136/emermed-2024-214467","url":null,"abstract":"<p><strong>Introduction: </strong>Children with head injury are commonly transported to the ED by ambulance. However, most of those conveyed are deemed non-serious and are discharged at triage. Research is needed to explore the factors that influence paramedics when deciding to convey children with minor head injury to the ED, and to establish whether a clinical decision tool designed to support them would be beneficial.</p><p><strong>Methods: </strong>A generic qualitative approach, comprising semistructured interviews with front-line ambulance paramedics working in the UK. Interviews were audio-recorded and transcribed. Data were analysed using reflexive thematic analysis. Interviews aimed to explore the factors that influence paramedics when deciding to convey children with minor head injury to the ED.</p><p><strong>Results: </strong>A total of 20 paramedics from several ambulance services participated in interviews. Three overarching themes were identified: 'we just take them in'; 'there are too many hurdles'; 'creating the right tool'. These were further categorised into subthemes. Paramedics do not feel confident when assessing and managing children with head injury, and convey children to hospital due to fear of consequences, despite knowing there will be no intervention in the ED. Further education, a prehospital paediatric clinical decision tool and greater support from Ambulance Trusts would be welcomed by paramedics. Criteria such as: parental anxiety; time; wound closure; policy and non-accidental injury need to be considered in a clinical decision tool designed to support paramedics' management of children with head injury.</p><p><strong>Conclusion: </strong>Paramedics generally feel a lack of confidence in assessing and managing children with head injury. A decision tool, coupled with training and useful feedback from EDs following conveyance, would be useful to help improve decision-making.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knowledge of initial management of caustic ingestions: a national survey of emergency physicians in France.","authors":"Maurane Le Strat, Helene Corte, Benoit Plaud, François Dépret, Benjamin Deniau","doi":"10.1136/emermed-2024-214546","DOIUrl":"https://doi.org/10.1136/emermed-2024-214546","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contact with emergency departments and hospitals in England before suicide death: a retrospective cohort study.","authors":"Frances Healey, Janine Gower, Matthew Fogarty, Gina Winter-Bates, Aidan Fowler","doi":"10.1136/emermed-2024-214440","DOIUrl":"https://doi.org/10.1136/emermed-2024-214440","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic accuracy of point-of-care ultrasound of the posterior fatpad in elbow fractures.","authors":"Svenja L Haak, Thea van der Veen, Renate Stolmeijer, Annemieke E Boendermaker, Brigitta Britt Ym van der Kolk, Jan C Ter Maaten, Ewoud Ter Avest, Heleen Lameijer","doi":"10.1136/emermed-2024-214448","DOIUrl":"https://doi.org/10.1136/emermed-2024-214448","url":null,"abstract":"<p><strong>Background: </strong>Point-of-care ultrasound (POCUS) can potentially be used in the triage of patients with elbow injuries. However, the diagnostic accuracy of POCUS performed by non-radiologists for the exclusion of elbow fractures is yet unknown. This study aimed to investigate the diagnostic potential of POCUS of the posterior fatpad performed by non-radiologists in the workup of adult patients presenting with elbow injuries.</p><p><strong>Methods: </strong>A multicentre, prospective cohort study was conducted between January 2021 and August 2022 in four EDs to determine the diagnostic accuracy of an elevated posterior fatpad on POCUS to demonstrate or exclude an elbow fracture in patients presenting with elbow injuries to the ED. The study population consisted of a convenience sample. In patients ≥16 years of age with an elbow injury for which an X-ray was ordered, POCUS was performed by emergency physicians trained in ultrasound. POCUS (index test) results were compared with X-ray outcomes (reference standard) to determine the diagnostic accuracy of POCUS.</p><p><strong>Results: </strong>A total of 215 patients were included, 143 (67%) of whom had a fracture confirmed on X-ray. POCUS was positive based on a visualised elevated posterior fatpad in 127 (59%) patients. An elevated posterior fatpad on POCUS had a sensitivity of 91% (95% CIs 85% to 95%), a specificity of 93% (95% CI 85% to 98%), a negative likelihood ratio of 0.10 (95% CI 0.06 to 0.16) and a positive likelihood ratio of 13.09 (95% CI 5.61 to 30.54) for the presence of an elbow fracture. Post hoc review of the images by expert sonographers improved sensitivity to 96% (95% CI 91% to 99%).</p><p><strong>Conclusion: </strong>POCUS of the posterior fatpad is a promising adjunct to physical examination to determine the need for further diagnostic studies in the triage of patients with elbow injuries. Sensitivity after a limited training is high, but not perfect, and can likely further be improved with additional training.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143028211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correspondence on 'Triage in major incidents: development and external validation of novel machine learning-derived primary and secondary triage tools' by Xu <i>et al</i>.","authors":"Giles N Cattermole, Colin A Graham","doi":"10.1136/emermed-2024-214135","DOIUrl":"10.1136/emermed-2024-214135","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"146"},"PeriodicalIF":2.7,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}